Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.86 / $102.33 / $389.05	Facility	26	$75.86	$102.33	$389.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $295.12 / $691.83	Professional		$218.78	$295.12	$691.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $104.71 / $269.15	Professional	26	$75.86	$104.71	$269.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $173.78 / $295.12	Professional	TC	$138.04	$173.78	$295.12
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $323.59 / $467.74	Professional		$234.42	$323.59	$467.74
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $114.82 / $162.18	Professional	26	$81.28	$114.82	$162.18
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $208.93 / $295.12	Professional	TC	$147.91	$208.93	$295.12
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $257.04 / $1,023.29	Professional		$223.87	$257.04	$1,023.29
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $85.11 / $107.15	Professional	26	$77.62	$85.11	$107.15
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $173.78 / $208.93	Professional	TC	$154.88	$173.78	$208.93
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $93.33 / $131.83	Facility	26	$19.95	$93.33	$131.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $346.74 / $549.54	Professional		$239.88	$346.74	$549.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $117.49 / $194.98	Professional	26	$83.18	$117.49	$194.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $208.93 / $354.81	Professional	TC	$151.36	$208.93	$354.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $269.15 / $338.84	Professional		$213.80	$269.15	$338.84
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $89.13 / $112.20	Professional	26	$70.79	$89.13	$112.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $177.83 / $223.87	Professional	TC	$144.54	$177.83	$223.87
Medcost Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $389.05 / $436.52	Professional		$309.03	$389.05	$436.52
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $147.91 / $154.88	Professional	26	$117.49	$147.91	$154.88
Medcost Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $288.40 / $288.40	Professional		$288.40	$288.40	$288.40
Sentara Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $275.42 / $524.81	Professional		$104.71	$275.42	$524.81
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $120.23 / $181.97	Professional	26	$87.10	$120.23	$181.97
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $218.78 / $346.74	Professional	TC	$154.88	$218.78	$346.74
United Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $295.12 / $467.74	Professional		$199.53	$295.12	$467.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $104.71 / $173.78	Professional	26	$70.79	$104.71	$173.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $186.21 / $302.00	Professional	TC	$125.89	$186.21	$302.00